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Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Authors
 Donghee Han  ;  Br ıain O. Hartaigh  ;  Heidi Gransar  ;  Ji Hyun Lee  ;  Asim Rizvi  ;  Lohendran Baskaran  ;  Joshua Schulman-Marcus  ;  Allison Dunning  ;  Stephan Achenbach  ;  Mouaz H. Al-Mallah  ;  Daniel S. Berman  ;  Matthew J. Budoff  ;  Filippo Cademartiri  ;  Erica Maffei  ;  Tracy Q. Callister  ;  Kavitha Chinnaiyan  ;  Benjamin J.W. Chow  ;  Augustin DeLago  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Philipp A. Kaufmann  ;  Gilbert Raff  ;  Leslee J. Shaw  ;  Todd C. Villines  ;  Yong-Jin Kim  ;  Jonathon Leipsic  ;  Gudrun Feuchtner  ;  Ricardo C. Cury  ;  Gianluca Pontone  ;  Daniele Andreini  ;  Hugo Marques  ;  Ronen Rubinshtein  ;  Niree Hindoyan  ;  Erica C. Jones  ;  Millie Gomez  ;  Fay Y. Lin  ;  Hyuk-Jae Chang  ;  James K. Min 
Citation
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol.19(6) : 675-683, 2018 
Journal Title
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING 
ISSN
 2047-2404 
Issue Date
2018
Keywords
elderly ; risk assessment ; coronary computed tomography angiography ; coronary artery calcium score
Abstract
Aims: Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults. Methods and results: Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1-49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18-41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, P-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; P-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles. Conclusion: CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.
Files in This Item:
T201804707.pdf.pdf Download
DOI
10.1093/ehjci/jex150
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jee Hyun(이지현)
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Han, Donghee(한동희)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/166796
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